Aspirin chemoprophylaxis is not a substitute for colorectal cancer screening

Theuer, Charles P. MD PhD

Departments of Surgery and Medicine; University of California, Irvine, USA

Abstracted from:Ladabaum U, Chopra CL, Huang G, Scheiman JM, Chernew ME, Fendrick AM. Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer. A cost-effectiveness analysis. Ann Int Med 2001; 135: 769-781 .

Evidence-based Healthcare 6(3):p 136, September 2002.

BACKGROUND

Screening decreases colorectal cancer incidence and mortality rates, although adherence may be low. Aspirin may reduce the risk of colorectal cancer. Its effectiveness as a substitute for, or adjunct to screening is unknown.

OBJECTIVE

To assess the cost-effectiveness of aspirin chemoprophylaxis in relation to colorectal cancer screening.

METHOD

Systematic review and cost-effectiveness analysis.

SEARCH STRATEGY

MEDLINE; 1980 to 1999.

INCLUSION/EXCLUSION CRITERIA

Studies of aspirin therapy and colorectal cancer screening for 50 to 80 year olds were eligible. Screening involved colonoscopy every 10 years or yearly faecal occult blood testing plus flexible sigmoidoscopy every 5 years. Cost effective analysis used a Markov model with third-party payer perspective.

OUTCOMES

Discounted cost per life-year gained.

MAIN RESULTS

Aspirin complications decreased life-years and increased costs. In people already taking aspirin, screening cost US$31,000 per life-year gained. When taken as an adjunct to colonoscopy every 10 years, the cost was US$149,161 per life-year gained.

AUTHORS' CONCLUSIONS

Aspirin chemoprophylaxis is not a cost-effective adjunct for patients undergoing colorectal cancer screening. Screening adherence should be improved rather than relying on aspirin for chemoprevention.